HHS on EMR Adoption and Paying to Keep People Healthy

Medgadget recently had the chance to sit down with U.S. Department of Health Human Services officials at a recent roundtable discussion. Todd Park, HHS Chief Technology Officer, touched on a number of topics, ranging from the Health Data Initiative and the importation of Blue Button data. Here, Park touches on his views on electronic medical records(EMR) and what he sees as one of the most-important trends in medicine: the shift from fee-for-service healthcare to what he refers to as a pay-to-keep-people-healthy mode. Joining Park in the meeting was Joe McCannon, Senior Advisor to the Administrator at the Centers for Medicare and Medicaid Services (CMS).

Medgadget: What are your thoughts on EMR adoption and the meaningful-use incentive program meant to support it?

Park: There’s very exciting progress on that front. Over 80,000 providers, as of July 31 of this year, had registered to participate in the meaningful use program, which is a great start. Something like close to 90,000 providers have actually registered to work with the regional extension centers for health IT that are set up around the country—[this effort is] kind of in the spirit of agriculture extension centers at the turn of the 20th century that helped to disseminate new technology to farmers to drive an exponential improvement in the productivity of American farming.

So, it’s still early, obviously, but the early signs are promising. And I would say that meaningful use is just the appetizer when it comes to the incentive to use health IT to improve health and care. The main event is movement from fee-for-service medicine to pay-to-keep-people-healthy model because, in that regime, you have to coordinate care across lots of different providers, you have to keep track of your patients, understanding what care they have and haven’t gotten, and actually identify the gap in care or stitch in time that would save the ER admit or the hospitalization. You’d have to reach beyond the walls of your medical office and engage with folks who have chronic disease to help them actually manage their health. These are things that are impossible without electronic health records and data and IT.

So, meaningful use I think of as an aid to help you get going with health IT. But the thing that’s really the long-term business case for adopting and using electronic health records is the fact that [doctors in the future] are going to be paid for keeping people healthy and health IT is going to be an essential part of doing that.

Medgadget: Will there be national standards for interoperability between electronic medical systems to enhance medical record sharing?

Park: Yes [laughter], absolutely! So the Office of the National Coordinator for Health Information Technology has in a very open, public process, with the help of the Health IT Policy Committee and Health IT Standards Committee, has been engaged to do exactly that and has promulgated a whole bunch of standards that people can use and is going to continue to iterate those over time.

Joe McCannon, Senior Advisor to the Administrator at CMS: Take the case of my sister: she’s a doctor in Boston. I think of the way that she practices today—she uses a handheld. She is constantly updating information about new drugs and new procedures and she’s on top of the evidence base. She’s sort of rabid about that.

Where we want to go is to a state where she is every bit as interested in the overall performance of her panel of patients or people in her zip code or people in her health referral region. And, so, that’s the image of where we ultimately want to be. It’s kind of like health services researchers carried out not by academics off on the side but by people who are actually in the system at the front lines, constantly being fed this information and responding to it. That’s ideally where we’d like to be.

Right now, if you ask my sister about the health of the population that she manages or tends to, she couldn’t tell you. She could tell everything you wanted to know about her patient Mrs. Smith and she can understand that inside and outside. But she, in terms of trends or aggregate challenges, or population health problems, that analysis isn’t totally available. She could probably guess and say, well I see patients with a lot of cardiovascular disease and diabetes because I’m dealing with this type of population. But, without this kind of information at her fingertips, it’s a little bit of bumping around in the dark.

Once the macroeconomics change, once the incentives change, she could say, “now wait a second. I’ve actually really got to care about this. I’ve got to care about how healthy I’m keeping people because if I’m keeping people healthier, that actually financially makes sense for me and my practice.”

Park: A lot of primary care docs actually want to do this. They are very angry about the payment system, where they have to see people ever 17 seconds because the get paid by the visit. So, clinical depression among primary care doctors is on the rise. And I’m convinced that it is because of this growing discrepancy between what they want to do and what the system forces them to do. Imagine, if, literally, a primary doc today said: I’m going to start coordinating care across all of the specialists in the hospital, I’m going to start hiring counselors and educators and case managers to help people stay healthy, I’m going to invest in technology to reach out beyond walls of my medical office and engage people in their care. [If they did that], they’d go bankrupt. They can’t do it, which is why the incentive change to pay to keep patients healthy is so important. It will unlock primary care doctors’ desire to do care they way they want to do it.

And then these tools, with the help of liberated data, will help them do it. So that’s one big macro-theme. You can’t just do information liberation by itself and expect maximum benefit. You can’t just do incentive change by itself and expect maximum benefit. You’ve got to do those two at the same time. And the great news is that we are actually doing both of those at the same time, so they can come together and [lead to a] beneficial change system for the healthcare system.

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